Improvement in Pulmonary Pressure in Patients with Pulmonary Hypertension Due To Left Heart Disease: Characteristics and Outcome

Background: Pulmonary hypertension due to left heart disease (PH-LHD) is the most frequent cause of PH encountered in clinical practice. While no specific therapy is known for these patients, current medical management is aimed for treating heart failure. The aim of the current study is to investigate possible causes for improvement in PH-LHD and its impact on survival.

Methods: Retrospective analytic study. Analyzing electronic files of patients older than 18 years, with transthoracic echocardiograms (TTE) performed from 1992 to 08/2015 at Shaare Zedek Medical Center consistent with PH-LHD (increased tricuspid incompetence gradients, TIG ≥40 mmHg) and a second TTE performed 3-24 months later.

Results: 12,115 patients were found to have PH. PH-LHD was the most prevalent cause of PH, a total of 8,306 patients (69%). Of 2126 (25.6%) patients with a follow-up TTE 850 (40%) improved pulmonary pressure by more than 10 mmHg. TIG improved from 47[42-55] to 42 [33-51] mmHg, p10mmHg were younger (70.8±13, vs 72.8±12 years, p=0.001) fewer were females (46.4% vs 52% p=0.011) had higher baseline TIG (52[45-60] vs 45[42-51] mmHg, p<0.0001; baseline echocardiography performed during hospitalization (68% vs 59% p<0.001) and valve abnormality the etiology of PH-LHD (75.8% vs 69.2% p=0.001). Valve intervention (surgical and percutaneous) was more frequent in those that improved TIG (11.6% vs 5.7% p<0.001). In a multivariate model, independent correlates of delta TIG>10mmHg were: higher TIG, non-diabetic, evaluation during hospitalization and performing valve intervention. In a multivariate model for mortality including these variables, improved TIG>10mmHg was associated with reduced mortality (HR = 0.69 95%CI [0.59-0.81] p<0.0001)

Conclusion: A significant number (40%) improved pulmonary hypertension caused by left heart disease. Improvement >10mmHg is associated with evaluation during hospitalization and with valve intervention. Regardless, improved TIG>10mmHg is an independent marker of better survival.